VEXUS protocol as a prognostic tool in acute heart failure: A systematic review and Bayesian meta-analysis

Area of Science:

• Cardiology
• Critical Care Medicine
• Diagnostic Ultrasound

Background:

• Systemic venous congestion is a critical prognostic factor in acute heart failure (AHF).
• The Venous Excess Ultrasound (VExUS) score is a promising bedside tool for assessing congestion.
• The prognostic significance of VExUS in AHF requires further investigation.

Purpose of the Study:

• To evaluate the association between the VExUS score and in-hospital mortality in patients with AHF.
• To determine if VExUS can serve as a reliable prognostic marker in AHF.

Main Methods:

• A systematic literature search was conducted across PubMed, Embase, and the Cochrane Library.
• A Bayesian random-effects meta-analysis compared in-hospital mortality between patients with VExUS scores ≤1 and ≥2.
• Five studies encompassing 565 AHF patients were included in the analysis.

Main Results:

• Patients with VExUS scores ≥2 exhibited significantly higher in-hospital mortality (14.1%) compared to those with VExUS ≤1 (1.9%).
• The meta-analysis revealed a strong association between lower VExUS grades and reduced in-hospital mortality (OR=0.175).
• The probability of a clinically relevant effect (OR<0.8) was 99.93%, indicating high confidence in the findings.

Conclusions:

• Lower VExUS scores are significantly associated with decreased in-hospital mortality in AHF patients.
• The VExUS score demonstrates utility as a bedside tool for prognostic risk stratification in AHF.
• These findings support the integration of VExUS assessment into routine AHF management.